Examining health visiting expertise: combining simulation, interview and observation

Background. Resource constraints and the drive towards evidence-based practice are currently prompting the review of health visiting services, which are a costly element of community health services in the United Kingdom. There is a shortage of evidence about effective domiciliary health visiting practice that can inform local and national decisions about developing and reforming this service. Aims. This paper is based on a study which aimed to articulate the health visiting expertise involved in recognizing and responding to client need during home visits. The paper describes the innovative, multi-method approach used to articulate this expertise, and presents the rationale for this unusual approach. Discussion. The study used the complementary methods of a 20-minute simulated visit to an actress-client, a postsimulation focused interview and subsequent observation of actual home visits with 15 study participants. Data-gathering took place between 2001 and 2002. The rationale, strengths and limitations of the methodology are discussed, and recommendations made for further development based on the work. Conclusions. The findings confirmed the utility of this unusual combination of methods, with their blend of control and naturalism, for articulating the knowledge and expertise which underpins assessment practice. Further research using a similar approach is recommended for the systematic examination of professional expertise in nursing and multi-disciplinary contexts.